Iskandarov A I, Indiaminov S I, Zhurayev I G
Republican Research and Practical Centre for Forensic Medicine, Tashkent, Uzbekistan.
Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan.
Sud Med Ekspert. 2023;66(5):33-39. doi: 10.17116/sudmed20236605133.
Is to refine the mechanism of major joints' damage formation and qualification criteria of harm degree to the health in articular injuries. The number of patients equal 246, suffered in different circumstances, were examined. Damages of skin and soft tissues in the joints region without affection of internal structures (47%), intraarticular fractures with impaired articular surface congruence (18.0%) and periarticular fractures (15.8%) were the most frequent in non-fatal injuries' outcomes in pedestrians and cyclists suffered from collisions with moving vehicles. Dead pedestrians and cyclists injured in road traffic accidents (RTA) from the side of joints structure had the most frequent the periarticular fractures (6.8%), intraarticular fractures with impaired (14.5%) or intact articular surface congruence (6.5%). Dislocations (45.9%) and dislocation-fracture (54.1%) were common in mechanical injuries. Mostly, work ability was recovered for 1.5-2.0 months in the presence of periarticular fracture, and there was no permanent loss of general work ability. The permanent loss of general work ability exceed 33.0% in case of complicated intraarticular fractures of coxofemoral structures, and in the case of a similar injury of other joints was less than this value. The period of work ability recovery in the case of intraarticular fractures was 2.5-3 months, in the presence of complicated dislocations was from 3 to 6 months. The permanent loss of general work ability did not exceed 30%. The period of work ability recovery in patients with fracture-dislocation varied from 3 to 6 months. The permanent loss of general work ability in this case was from 20% to 60%. The severity of harm to the health was classified as moderate degree in the case of uncomplicated isolated injuries of joints structures, and as moderate or severe degree in the presence of complicated isolated injuries. Bruises of joints' soft tissues were evaluated as mild bodily injury causing a health disorder. Bruises of joints' soft tissues, as well as periarticular and intraarticular fractures in pedestrians and cyclists in the case of RTA are formed when falling on the road surface. Dislocations and fractures-dislocations of humerus and forearm occur as a result of an indirect injury mechanism. Articular injuries of femur are formed under the influence of traumatic force to the femur, exceeding the capability of coxofemoral joint (an indirect injury mechanism). Dislocations and fractures-dislocations in ankle joint are occurred as a result of an indirect injury mechanism and are caused by foot's flexion or rotation with great strength.
目的是完善主要关节损伤形成机制及关节损伤对健康危害程度的评定标准。对246例在不同情况下受伤的患者进行了检查。关节区域皮肤和软组织损伤但内部结构未受影响（47%）、关节面一致性受损的关节内骨折（18.0%）和关节周围骨折（15.8%）是行人和骑自行车者与行驶车辆碰撞非致命损伤结果中最常见的情况。在道路交通事故（RTA）中死亡的行人和骑自行车者，从关节结构方面看，关节周围骨折最为常见（6.8%），关节面一致性受损（14.5%）或完整的关节内骨折（6.5%）。机械性损伤中脱位（45.9%）和脱位骨折（54.1%）很常见。在有关节周围骨折的情况下，工作能力大多在1.5至2.0个月内恢复，且一般工作能力无永久性丧失。在髋股结构复杂关节内骨折的情况下，一般工作能力的永久性丧失超过33.0%，而在其他关节类似损伤的情况下则低于此值。关节内骨折情况下工作能力恢复时间为2.5至3个月，复杂脱位情况下为3至6个月。一般工作能力的永久性丧失不超过30%。骨折脱位患者工作能力恢复时间为3至6个月。在这种情况下，一般工作能力的永久性丧失为20%至60%。关节结构单纯损伤不复杂时，对健康的危害程度分类为中度，而存在复杂单纯损伤时则为中度或重度。关节软组织挫伤被评估为导致健康紊乱的轻度身体损伤。在RTA情况下，行人和骑自行车者关节软组织挫伤以及关节周围和关节内骨折是在摔倒在路面时形成的。肱骨和前臂的脱位及骨折脱位是间接损伤机制导致的。股骨的关节损伤是在对股骨的创伤力超过髋股关节承受能力的影响下形成的（间接损伤机制）。踝关节的脱位及骨折脱位是间接损伤机制导致的，是由足部强力屈曲或旋转引起的。
